Successful Face Transplants Performed

Editor's Choice
Main Category: Transplants / Organ Donations
Also Included In: Cancer / Oncology;  Ear, Nose and Throat
Article Date: 23 Aug 2008 - 0:00 PDT

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Two men have undergone face transplants -- one after being attacked by a bear and another after suffering from a large facial tumor -- and they have indicated promising results. These cases indicate that the procedure might be used more regularly for long-term restoration of facial disfigurement, and are described in two articles released in The Lancet on August 22, 2008 describe face transplants that were performed in 2006 and 2007 which appear to have promising results.

Organ transplants can take on many forms. In a process called an autograft, expendable tissue from one person is transplanted from one part of the body to another. Examples of autografts include skin grafts and vein extraction for use in a coronary bypass surgery. In contrast, transplants of the heart, lung, or kidney use a slightly different process known as an allograft. This involves transplantation of the organ from one person to another person, often to replace a non-functional organ in the latter.

Allografts can often suffer complications that autografts do not, in particular due to the immune response of the recipient against the foreign "material" from the latter. Transplantation of the face already has many challenges due to its shape, diversity of expression, and social significance. As a result, experimentation in allograft face transplants is relatively undeveloped, with only one previously documented attempt.

In October 2004, the first subject, a 30 year old Chinese man, was attacked by a bear, leaving him facial disfigurement. On April 13, 2006, allograft transplantation was performed in the Xijing Hospital and Fourth Military Medical University, Xi'an, China. This surgery had many facets to integrate with the existing physiology, including the connection of arteries and veins, as well as nose, lip, and sinus repair, among others. In addition to drugs to prevent subsequent infection, the patient was administered a combination of four drugs to help mitigate the immune response and thus decrease chances of rejection.

According to the article, this new tissue flap had good survival in the new facial environment. Three acute rejection episodes occurred, at three, five, and 17 months after the surgery. These were brought back into control by adjusting the dose of one of the immune modulating drugs or through administration of a steroid. His kidneys and liver, often susceptible to complications after surgeries, functioned normally, and no infection was experienced. The authors concluded that there is great potential for facial transplantation in extreme cases: "Facial transplantation could be successful in the short term, but the procedure is not without complications...This case suggests facial transplantation might be an option for restoring a severely disfigured face, and could enable patients to readily integrate themselves back into society."

The second patient, a 29-year-old male, suffered from a seriously disfiguring facial tumor in the middle and lower parts of his face, classified as a neurofibroma. On January 21, 2007, he underwent the transplantation surgery at the Henri Mondor Hospital (APHP) of Creteil, France, and was subsequently administered drugs to suppress immune rejection. After the surgery, he was evaluated for motor function and psychological response.

The patient experience two clinical rejection instances, at days 28 and 64, with the latter attack associated with a cytomegalovirus infection that was linked to the donor tissue. Both rejection episodes resulted in favorable outcomes, allowing doctors to reduce the immunosuppressive treatment regimen. As of one year of followup, the patient's sensation and motor function had returned in the transplant region, and the patient showed excellent psychological recovery and social reintegration. He was able to begin working full time 13 months after the surgery.

The authors conclude that this procedure also shows promise for future facial transplants: "Our case confirms that face transplantation is surgically feasible and effective for the correction of specific disfigurement, due in this case to a genetic disorder...Long-term follow-up is needed to assess the risks linked to the immunogenicity of allogenic composite tissues, particularly as regards life expectancy. Following this initial success, other patients are currently being assessed."

Dr Jean-Michel Dubernard, E Herriot University Lyon I Hospital, France, and Dr Bernand Devauchelle, Amiens-Nord University Hospital, Amiens, France, contributed an accompanying comment on both articles, stating that by collaborating, the teams developing these operations could make great strides "to answer the many technical, functional, immunological, and psychological questions raised by face transplantation." They conclude that other types of conditions that may indicate transplant may be improved as a result: "The definition of the best indications -- eg, trauma, malformations, benign tumours, burns -- will also greatly benefit from this cooperation. The International Registry on Hand and Composite Tissue Transplantation would be an ideal forum to help solve these challenges and define new indications. Our main objective is to give back a normal life to disfigured patients."

Human facial allotransplantation: a 2-year follow-up study
Shuzhong Guo, Yan Han, Xudong Zhang, Binglun Lu, Chenggang Yi, Hui Zhang, Xianjie Ma, Datai Wang, Li Yang, Xing Fan, Yunjing Liu,
Kaihua Lu, Huiyuan Li
Lancet 2008; 372: 631-38
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Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study
Laurent Lantieri, Jean-Paul Meningaud, Philippe Grimbert, Frank Bellivier, Jean-Pascal Lefaucheur, Nicolas Ortonne, Marc-David Benjoar,
Philippe Lang, Pierre Wolkenstein
Lancet 2008; 372: 639-45
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Face transplantation
Jean-Michel Dubernard, Bernard Devauchelle
Lancet 2008; 372: 603-604
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Written by Anna Sophia McKenney
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